Section 240.865  Application For Medical Assistance (Medicaid)

Effective June 1, 2008, applicants will be required to make a good faith effort to apply for and, if financially eligible, enroll in medical assistance under Article V of the Illinois Public Aid Code as a condition of eligibility for the Community Care Program (CCP). 

a)         Exceptions to this enrollment requirement will be allowed only if the case manager can verify that:

1)         a denial was issued in response to a medical assistance application within the prior 24-month period and there is no action that can be taken by the applicant to become eligible for the program;

2)         the value of non-exempt assets that are owned by the applicant exceeds twice the level of the asset disregard limit for medical assistance;

3)         the applicant is prohibited from enrolling in medical assistance due to immigration status;

4)         the applicant has proof of private, creditable health insurance or U.S. Department of Veterans Affairs benefits and/or coverage for a spouse for the next 12-month period of time; or

5)         compelling circumstances exist making such effort an undue hardship on the applicants (e.g., the unavailability of documentation, a disability or chronic physical impairment of the applicant renders him or her unable to participate in the eligibility determination process, refusal to enroll in medical assistance would result in denial or termination of service that places the applicant/client at imminent risk of nursing facility placement within 3 work days, etc.).

b)         The case manager shall, when needed:

1)         provide the applicant with a copy of the mail-in medical assistance application;

2)         assist the applicant with completing the application; and

3)         submit the application to the applicant's local Family Community Resource Center (FCRC).

c)         A good faith effort includes obtaining, completing and submitting a medical assistance application, together with any required supporting documentation.

d)         Services shall be provided to applicants by the Department during the period in which a medical assistance application is pending.

e)         Although applicants must agree to apply for and, if financially eligible, enroll in medical assistance, applicants are not required to meet the eligibility criteria for medical assistance under Article V of the Illinois Public Aid Code to receive benefits under the Community Care Program.

(Source:  Amended at 32 Ill. Reg. 17929, effective November 10, 2008)